PRINTER'S NO. 499
No. 479 Session of 1999
INTRODUCED BY PISTELLA, SCHULER, THOMAS, LEDERER, SOLOBAY,
WOJNAROSKI, MELIO, LAUGHLIN, WILLIAMS, MUNDY, PESCI, WALKO,
ORIE, CURRY, VAN HORNE, SCRIMENTI, TRELLO, PRESTON,
MICHLOVIC, READSHAW, HARHAI, TANGRETTI, STEVENSON,
YOUNGBLOOD, JOSEPHS AND STEELMAN, FEBRUARY 9, 1999
REFERRED TO COMMITTEE ON AGING AND YOUTH, FEBRUARY 9, 1999
AN ACT
1 Providing for pediatric extended care centers, for licensure,
2 for fees, for duties of the Department of Health and for
3 enforcement; regulating construction and renovation; and
4 providing for penalties, for creation of the Pediatric
5 Extended Care Fund and for disposition of fees.
6 TABLE OF CONTENTS
7 Section 1. Legislative intent.
8 Section 2. Definitions.
9 Section 3. PPEC centers to be licensed; exemptions.
10 Section 4. License required; fee; exemption; display.
11 Section 5. Initial application for license.
12 Section 6. Denial, suspension, revocation of license and
13 grounds.
14 Section 7. Administrative fines; disposition of fees and fines.
15 Section 8. Expiration of license; renewal; conditional license
16 as permit.
17 Section 9. Injunction proceedings authorized.
18 Section 10. Closing of PPEC center.
1 Section 11. Right to enter and inspect.
2 Section 12. Rules establishing standards.
3 Section 13. Construction and renovation; requirements.
4 Section 14. Prohibited acts; penalty for violation.
5 Section 15. Creation of fund; disposition of moneys from fines
6 and fees.
7 Section 16. Effective date.
8 The General Assembly of the Commonwealth of Pennsylvania
9 hereby enacts as follows:
10 Section 1. Legislative intent.
11 It is the intent of the General Assembly:
12 (1) To develop, establish and enforce licensure and
13 basic standards for prescribed pediatric extended care
14 centers.
15 (2) To assure that prescribed pediatric extended care
16 centers provide the necessary family-centered medical
17 treatment, developmental, physiological and family training
18 services and prescribed therapy services.
19 (3) To assure that all families, including those that
20 are economically challenged, have access to care provided by
21 these centers.
22 Section 2. Definitions.
23 The following words and phrases when used in this act shall
24 have the meanings given to them in this section unless the
25 context clearly indicates otherwise:
26 "Basic services." Include, but are not limited to,
27 development, implementation and monitoring of a comprehensive
28 protocol of patient care developed in conjunction with the
29 primary care physician and parent or guardian which specifies
30 the medical, nursing, psychosocial and developmental therapies
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1 required by the medically fragile or technologically dependent
2 child served, as well as the caregiver training needs of the
3 child's legal guardian.
4 "Department." The Department of Health of the Commonwealth.
5 "Medical records." Any and all medical records maintained in
6 accordance with accepted professional standards and practices as
7 specified in the rules implementing this act.
8 "Medically fragile or technologically dependent child." The
9 term includes any child who because of a medical condition
10 requires therapeutic interventions or skilled nursing
11 supervision that must be prescribed by a licensed physician and
12 administered by or under the direct supervision of a
13 professional registered nurse who is licensed in the
14 jurisdiction of the center.
15 "Owner" or "operator." Any individual who has general
16 administrative charge of a prescribed pediatric extended care
17 center.
18 "Prescribed Pediatric Extended Care center" or "PPEC center."
19 Any building or buildings or other place, whether operated for
20 profit or not, which undertakes through its ownership or
21 management to provide basic nonresidential services to seven or
22 more medically fragile or technologically dependent children who
23 are not related to the owner or operator by blood, marriage or
24 adoption and who require such services. Infants and children
25 considered for admission to a PPEC center must have complex
26 medical conditions that require therapeutic and nursing
27 intervention. Prerequisites for admission to the center are a
28 prescription and orders for medical care from the child's
29 primary care physician and consent of a parent or guardian.
30 "Supportive services" or "contracted services." Include, but
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1 are not limited to, speech therapy, occupational therapy,
2 nursing care, physical therapy, social work, developmental child
3 life and psychological services.
4 Section 3. PPEC centers to be licensed; exemptions.
5 Facilities to be licensed by the department shall include all
6 PPEC centers that are defined in this act and are not otherwise
7 exempt. A facility, institution or other place operated by the
8 Federal Government, or any agency thereof, is exempt from the
9 provisions of this section.
10 Section 4. License required; fee; exemption; display.
11 (a) License required.--It is unlawful to operate or maintain
12 a PPEC center without first obtaining from the department a
13 license authorizing such operation. The department is
14 responsible for licensing PPEC centers in accordance with the
15 provisions of this section. Any person who violates this section
16 commits a felony of the third degree.
17 (b) Premises.--Separate licenses are required for PPEC
18 centers maintained on separate premises, even though they are
19 operated under the same management. Separate licenses are not
20 required for separate buildings on the same grounds.
21 (c) Fee.--The annual license fee required of a PPEC center
22 shall be in an amount determined by the department to be
23 sufficient to cover the department's costs in carrying out its
24 responsibilities under this act, but shall not be less than $500
25 nor more than $1,000.
26 (d) Exemption.--County-operated or municipally operated PPEC
27 centers applying for licensure under this section are exempt
28 from the payment of licensing fees.
29 (e) Display.--Any and all licenses required by this section
30 or other statutes or acts shall be displayed in a conspicuous
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1 place inside the PPEC center.
2 (f) Assignment.--A license under this act shall be valid
3 only while in the possession of the individual, firm,
4 partnership, association or corporation to whom it is issued. At
5 no time shall any license granted under this act be subject to
6 sale, assignment or other transfer, voluntary or involuntary,
7 nor shall a license granted under this act be valid for any
8 premises other than that for which it was originally issued.
9 (g) Contents.--Any license granted by the department shall
10 state a maximum capacity of the facility, the date the license
11 was issued, the expiration date of the license and any other
12 information deemed necessary by the department.
13 Section 5. Initial application for license.
14 Application for license shall be made to the department on
15 the prescribed forms and shall be accompanied by the appropriate
16 license fee unless the applicant is exempt from payment of the
17 fee as provided in section 4.
18 (1) The application shall be made under oath and shall
19 contain the following information and statements:
20 (i) The name and address of the applicant and the
21 name by which the facility is to be known:
22 (A) If the applicant is a firm, partnership or
23 association, the application shall contain the name
24 and address of every member thereof.
25 (B) If the applicant is a corporation, the
26 application shall contain its name and address, the
27 name and address of each of its directors and
28 officers and the name and address of each person
29 having at least a 10% interest in the corporation.
30 (2) The application shall contain information which
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1 provides a source to establish the suitable character and
2 competency of the owner or operator, including the name and
3 address of any licensed facility with which the applicant or
4 owner or operator has been affiliated through ownership or
5 employment within five years of the date of the application
6 for a license.
7 (3) The application shall include the names and
8 addresses of other persons of whom the department may inquire
9 as to the character and reputation of the applicant and, if
10 applicable, of the owner or operator.
11 (4) The application shall include the names and
12 addresses of other persons of whom the department may inquire
13 as to the financial responsibility of the applicant.
14 (5) The application shall include such other reasonable
15 information as may be required by the department to evaluate
16 the ability of the applicant to meet the responsibilities
17 entailed under this act.
18 (6) The application shall include the location of the
19 facility for which a license is sought and the documentation,
20 signed by the appropriate local government official, which
21 states that the applicant has met local zoning requirements.
22 (7) The applicant for licensure shall furnish at the
23 time of filing the application satisfactory proof of
24 financial ability to operate and conduct the PPEC center in
25 accordance with the requirements of this act.
26 (8) The applicant for licensure shall furnish at the
27 time of filing the application proof of adequate liability
28 insurance coverage or protection.
29 Section 6. Denial, suspension, revocation of license and
30 grounds.
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1 The department may deny, revoke or suspend a license or
2 impose an administrative fine in the manner provided under this
3 act. Any of the following actions by a PPEC center or its
4 employees shall be grounds for action by the department against
5 a PPEC center or its employee:
6 (1) An intentional or negligent act materially affecting
7 the health and safety of children in the PPEC center.
8 (2) A violation of the provisions of this section or any
9 standards or rules adopted pursuant to this act.
10 (3) Multiple and repeated violations of this section or
11 of minimum standards or rules adopted pursuant to this act.
12 The department shall be responsible for all investigations and
13 inspections conducted pursuant to this act.
14 Section 7. Administrative fines; disposition of fees and fines.
15 (a) Operation without license.--If the department determines
16 that a PPEC center is being operated without a license or is
17 otherwise not in compliance with rules adopted under this act,
18 the department, notwithstanding any other administrative action
19 it takes, shall make a reasonable attempt to discuss each
20 violation and recommend corrective action with the owner of the
21 PPEC center prior to written notification thereof. The
22 department shall then request that the PPEC center submit a
23 corrective action plan that demonstrates a good faith effort to
24 remedy each violation by a specific date, subject to the
25 approval of the department.
26 (b) Fine.--The department may fine a PPEC center or employee
27 found in violation of rules adopted pursuant to this section an
28 amount not to exceed $500 for each violation. Such fine may not
29 exceed $5,000 in the aggregate.
30 (c) Correction.--The failure to correct a violation by the
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1 date set by the department or the failure by a PPEC center to
2 comply with an approved corrective action plan is a separate
3 violation for each day such failure continues unless the
4 department approves an extension to a specific date.
5 (d) Appeal.--If a PPEC center desires to appeal any
6 department action under this section and the fine is upheld, the
7 violator shall pay the fine plus interest at the legal rate for
8 each day beyond the date set by the agency for payment of the
9 fine.
10 (e) Determination.--In determining if a fine is to be
11 imposed and in fixing the amount of any fine, the department
12 shall consider the following factors:
13 (1) The gravity of the violation, including the
14 probability that death or serious physical or emotional harm
15 to a child will result, would have resulted or has resulted,
16 the severity of the actual or potential harm and the extent
17 to which the provisions of the applicable statutes or rules
18 were violated.
19 (2) Actions taken by the owner or operator to correct
20 violations.
21 (3) Any previous violations.
22 (4) The financial benefit to the PPEC center of
23 committing or continuing the violation.
24 Section 8. Expiration of license; renewal; conditional license
25 as permit.
26 (a) Expiration.--A license issued for the operation of a
27 PPEC center unless sooner suspended or revoked shall expire one
28 year after the date of issuance. At least 60 days before the
29 expiration date, and application for renewal shall be submitted
30 to the department. The department shall renew the license, upon
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1 the filing of an application on forms furnished by the
2 department, if the applicant has first met the requirements
3 established under this act and all rules adopted pursuant to
4 this act. The PPEC center shall file with the application
5 satisfactory proof of financial ability to operate and conduct
6 the facility in accordance with this act.
7 (b) Conditional license.--A licensee against whom a
8 revocation or suspension proceeding is pending at the time of
9 license renewal may be issued a conditional license effective
10 until final disposition of such proceedings by the department.
11 If judicial relief is sought from the final disposition, the
12 court having jurisdiction may issue a conditional permit for the
13 duration of the judicial proceeding.
14 Section 9. Injunction proceedings authorized.
15 The department may institute injunction proceedings in a
16 court or competent jurisdiction to:
17 (1) enforce the provisions of this section or any
18 standard, rule or order issued or entered into pursuant
19 thereto; or
20 (2) terminate the operation of the PPEC center if the
21 licensee has:
22 (i) Not taken preventive or corrective measures in
23 accordance with any order of the department.
24 (ii) Failed to abide by any final order of the
25 department once it has become effective and binding.
26 (iii) Committed a violation of any provision of this
27 act or any rule adopted under this act, the violation of
28 which constitutes an emergency requiring immediate
29 action.
30 Injunctive relief may be temporary or permanent.
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1 Section 10. Closing of PPEC center.
2 (a) Discontinuance.--Whenever a PPEC center voluntarily
3 discontinues operation, it shall inform the department in
4 writing at least 60 days before the discontinuance of operation.
5 The PPEC center shall also, at such time, inform each child's
6 legal guardian of the fact and the proposed time of the
7 discontinuance.
8 (b) Surrender of license.--Immediately upon discontinuance
9 of the operation of a PPEC center, the owner or operator shall
10 surrender the license to the department and the license shall be
11 canceled.
12 Section 11. Right to enter and inspect.
13 Any duly designated officer or employee of the department
14 shall have the right to enter upon and into the premises of any
15 PPEC center licensed under this act at any reasonable time in
16 order to determine the state of compliance with the provisions
17 of this act and of rules or standards in force pursuant to this
18 act. The right of entry and inspection shall also extend to any
19 premises which the department has reason to believe is being
20 operated and/or maintained as a PPEC center without a license.
21 However, no such entry or inspection of any premises shall be
22 made without the permission of the owner or operator in charge
23 unless a warrant is first obtained from the department or court
24 authorizing the entry and inspection. Any application for a PPEC
25 center license or renewal made pursuant to this section shall
26 constitute permission for a complete acquiescence in any entry
27 or inspection of the premises for which the license is sought in
28 order to facilitate verification of the information submitted on
29 or in connection with the application.
30 Section 12. Rules establishing standards.
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1 (a) Standards.--Pursuant to the intention of the General
2 Assembly to provide access to safe and sanitary facilities and
3 healthful programs, the department shall adopt and publish rules
4 and regulations to implement the provisions of this act which
5 shall include reasonable and fair standards. Any conflict
6 between these standards and those that may be set forth in
7 local, county or city ordinances shall be resolved in favor of
8 those having Statewide effect. The standards shall relate to:
9 (1) The assurance that PPEC center services are family-
10 centered and provide individualized medical, developmental
11 and family training services.
12 (2) The maintenance of PPEC centers based upon the size
13 of the structure and number of children, relating to
14 plumbing, heating, lighting, ventilation and other building
15 conditions, including adequate space, which will ensure the
16 health, safety, comfort and protection from fire of the
17 children served.
18 (3) The number and qualifications of all personnel who
19 have responsibility for the care of the children served.
20 (4) The qualifications of a medical director who will
21 provide direction in policy, procedure and patient care.
22 (5) The development of a policy making group, such as a
23 board of directors, to determine policies of the facilities.
24 (6) All sanitary conditions within the PPEC center and
25 its surroundings, including water supply, sewage disposal,
26 food handling and general hygiene, and maintenance thereof,
27 which will ensure the health and comfort of the children.
28 (7) The mandatory practice of universal precautions to
29 ensure appropriate infection control.
30 (8) The development and maintenance of appropriate
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1 patient care and general child care policies.
2 (9) Programs and basic services promoting and
3 maintaining the health and development of the children served
4 and meeting the training needs of the children's legal
5 guardians.
6 (10) Supportive, contracted, other operational and
7 transportation services.
8 (11) Maintenance of appropriate medical records, data
9 and information relative to the children and programs. Such
10 records shall be maintained in the facility for inspection by
11 the department.
12 (12) The availability of appropriate medical equipment,
13 emergency first aid equipment and supplies.
14 (b) Regulations.--The department shall adopt rules and
15 regulations to ensure that:
16 (1) No child attends a PPEC center for more than 12
17 hours within a 24-hour period.
18 (2) No PPEC center provides services other than those
19 provided to medically fragile or technologically dependent
20 children.
21 Section 13. Construction and renovation; requirements.
22 The requirements for the construction or renovation of a PPEC
23 center shall comply with:
24 (1) Provisions that pertain to building and construction
25 standards, including plumbing, electrical code, glass,
26 manufactured buildings and accessibility for the physically
27 disabled.
28 (2) The standards or rules adopted pursuant to this act.
29 Section 14. Prohibited acts; penalty for violation.
30 (a) General rule.--It is unlawful for any person or public
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1 body to offer or advertise to the public in any way or by any
2 medium basic services as defined under this act without
3 obtaining a valid current license. It is also unlawful for any
4 holder of a license issued pursuant to this act to advertise or
5 hold out to the public that it holds a license for a PPEC center
6 other than that for which it actually holds a license.
7 (b) Penalty.--Any person who violates the provisions of this
8 section commits a misdemeanor of the second degree. Each day of
9 continuing violation shall be considered a separate offense.
10 Section 15. Creation of fund; disposition of money from fines
11 and fees.
12 (a) Creation of fund.--There is hereby created within the
13 Department of Health a Pediatric Extended Care Fund to be used
14 to administer the provisions of this act.
15 (b) Disposition.--All moneys received from administrative
16 fines pursuant to section 7 and all moneys received from fees
17 collected pursuant to section 4 shall be deposited in the
18 Pediatric Extended Care Fund to be used for review and
19 enforcement of this act.
20 Section 16. Effective date.
21 This act shall take effect in 60 days.
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